The Production of Blisters by Hypnotic Suggestion: Another Look

The Production of Blisters by

Hypnotic Suggestion: Another LookGORDON L. PAUL, M.A.

This paper presents a critical evaluation of reported attempts to produce nonherpeticskin blisters through hypnotic suggestion. Even though the majority of these reports aregrossly lacking in controls, experimental design, etc., and are subject to alternative ex-planations, the author concludes that skin anomalies have been produced by sugges-tion in some instances. Additional studies of psychogenic vascular changes add cre-dence to the possibility of central control of these phenomena. It is also concluded thatthese reactions do not appear to be limited only to hypnotized Ss.

" 1LJIT . YPNOSIS" has been variously de-

fined by a multitude of authors since thetime of Mesmer's "animal magnetism." Arecent definition of the term by Gorton10

seems to be most inclusive and one whichfew current workers in the field woulddispute. Gorton states that hypnosis is"an artificially-induced state, character-ized by heightened suggestibility, as a re-sult of which certain sensory, motor, andmemory abnormalities may be inducedmore readily than in the normal state."Thus, defining hypnosis, it seems ratherstrange that Gorton proceeds to state thepurpose of his paper to be ". . . to examinethe physiological changes transcendingordinary voluntary capacity." This latterstatement reflects one side of a recurringargument about hypnosis. White31 wasprobably the most dogmatic exponent of

From the Department of Psychology, Univer-sity of Illinois, Urbana, 111.

The author wishes to thank Mrs. EvelyneDowns and Mrs. Joan Paul for assistance inpreparing the manuscript, and Professors C. W.Eriksen and L. I. O'Kelly for their commentsand recommendations.

Received for publication Aug. 29, 1962.

this view, stating that "hypnotic tran-scendence of voluntary capacity or voli-tional control" was one of the main fea-tures which makes hypnosis a perennialobject of wonder and amazement.White's main argument, also, was basedupon the physiological effects purportedat the time. Still, another investigator28

claims his "study" to show that: "Underhypnosis it is possible to demonstrate aninter-relationship between the psychicprocesses and localized peripheral effectswhich far transcends the ability of the in-dividual in the conscious state."

Another school of thought was stirringin the seeds of skepticism when Babinskiquestioned some of the physiological ef-fects attributed to hypnosis at a discussionheld in 1908 by the Societe de Neurologiein Paris.24 Young32 then demonstrated thenecessity of comparing hypnotic behaviorwith "normal waking behavior" if causa-tion is to be attributed to hypnosis. Youngfurther demonstrated that much behaviorunder hypnosis was due to subject (S)peculiarities, which could also be pro-duced in the waking state. Following

233

234 HYPNOTIC BLISTER PRODUCTION

closely on Young's footsteps, Hull12 pub-lished the first real scientific treatise deal-ing with hypnotic phenomena, in whichhe postulated the fundamental question—i.e., "Can organic functions which arenot under voluntary control be modifiedor controlled by hypnotic suggestion?"Hull concluded that all physiological ef-fects of hypnosis to that time could be ex-plained by (1) conditioned reflex, and(2) intercurrent emotional states. He alsoproposed changing the term of incident"involuntary control" of many autonomicfunctions to "indirect voluntary control,"since these functions could be elicited inwaldng Ss by just "talking."

Pattie24 pointed out that, though Hullhad done an excellent job of explainingcertain physiological effects, one series ofreports had been conspicuous in its ab-sence. This omission was the formation ofblisters from the touch of a cold object.The importance of this omission, Pattieclaims, is because "The processes whichproduce blisters on the skin are certainlynot under direct or indirect voluntarycontrol." Many reviewers since Pattie(e.g., Gorton,10 Weitzenhoffer,29 Sarbin,25

Orne,23 and Barber3) have turned atten-tion to reproducible physiological effectsin general, and nonherpetic blister pro-duction in particular. The consensus hasbeen (with the exception of Gorton) thatmost behavior of the so-called involuntaryfunctions which can be effected underhypnosis can also be obtained in the wak-ing state. As Weitzenhoffer29 reports,these effects only require a reorganizationin our thinking of psychosomatic andsomatopsychic relationships. Weitzenhof-fer29 and the more recent reviewer, Bar-ber,3 have done an admirable job in re-viewing the available evidence on thephysiological effects obtainable duringtrance, ranging from gastric functions towart reduction. Barber also demonstratesadequately that these same effects, if toa lesser degree, can also be produced inwaking Ss. The one effect which none ofthe reviewers has well demonstrated in

waking Ss, or really shown to exist inhypnotized Ss, is the same function whichPattie24 pointed out—i.e., the productionof (nonherpetic) blisters by hypnotic sug-gestion. One reviewer24 doubts that theeffect is tenable, lacking a specifiablemechanism; two reviewers3-29 point out asimilarity between wheal production andblister production but do not attempt toshow that direct suggestion could eliciteither; Gorton10 merely states that noavailable theory accounts for the phe-nomena, and is content to leave the sup-posed blister production as one of themarvelous mysteries of hypnosis, whileOrne23 and Sarbin25 attribute the effectto peculiar predispositions of the Ss. Thelatter author does attempt an explanationof the effect, which will be covered later.

In view of the above information, a re-view and evaluation of all reports onnonherpetic blister production seemednecessary: first, to determine if the "clini-cal lore" had any basis in fact; secondly,to review the physiology involved to seeif such an effect is tenable.

Survey of the Literature

Pattie,24 following Hull's treatise,12

took it upon himself to search through allthe literature up to 1941, including for-eign publications, reporting attempts atproducing blisters under hypnosis. Hewas able to find only 16 reported at-tempts, involving 14 Ss. Two of these re-ports were "scientifically without value,"due to a complete failure to give accountof the procedures used; one of the reportswas discounted because of discovery thatthe S had induced self-injury; and two re-ports, by experimenters who were re-tained, were excluded because of a failureto report procedure and controls used.Thus, Pattie was left with a total of 10articles covering 11 "experiments" in theperiod before 1941. Of these experiments,only one was in English, and the totalnumber of all the experiments was 11;

PSYCHOSOMATIC MEDICINE

PAUL 235these were not in a 1 to 1 proportion.Weitzenhoff er28 again surveyed the litera-ture, from 1886 to 1952, and found the ar-ticles reviewed by Pattie to be the onlyreports to give even a fair account of pro-cedures and controls. Barber3 was able tofind two additional reports of "successful"blister production since Pattie's paper.Wells30 reported an attempt, with ques-tionable results, and Sarbin23 reports thathe has attempted blister production andfailed. (No account was given of theprocedure, and therefore, according tothe Pattie-Weitzenhoffer criteria, is mean-ingless.) In a comprehensive review ofall the available literature, from 1953 to1962, the present writer was able to findonly one report of blister production un-der hynosis9 in addition to those reportedby Barber3 (See footnote, Table 1). Thislatter report can be discounted, also, be-cause of a complete failure in reportingprocedure and controls, plus the fact thatthe entire book is invalidated by the pop-ularized, mystical claims of the author.

Table 1 summarizes the primary fea-tures of the studies reported to date. Dis-regarding No. 15, we are left with a totalof 14 reports with a like number of Ss onwhich the phenomena of hypnotic blisterproduction is based. None of the experi-ments are exactly comparable in proce-dures or controls. Typically the generalprocedure was to hypnotize the S (all Sswere capable of a somnambulistic trance)and then touch some localized area ofskin with a definite object, suggesting thatthe object was "red hot" or would pro.duce a "burn," a "blister," "redness," orsome combination of these. In some casesthe stimulus object was left in contact forthe entire period, but in others contactwas only a pressure of short duration. Inone instance, No. 11, no object was used,the area being marked off bv a grease pen-cil. After suggestion, some Ss were "awak-ened" while others remained in a trancefor the entire period. Some gave directsuggestions as to the time of blister pro-duction while others did not. Some Es ob-

V<X. XXV, NO. 3. 1963

served the area for the duration of the ex-periment; some bandaged the area andobserved the S; some dismissed the sub-ject for periods of 4-48 hr. (in one in-stance, a full week) after suggestion-some bandaged and some not. In at leasttwo of the reports, No. 11, and 12, blisterproduction was only of secondary interest.Under "Results," Table 1, the reports inthe language of the various authors maybe found. The majority are limited to ex-ternal observations by laymen, but a fewwere dermatologists, and some performedbiopsies. Time intervals varied from 9min. to 24 hr. for blister production, andfrom immediately to 7 hr. for erythemaformation. In three instances, No. 3, 7,and 8, the blister was in a different loca-tion from the stimulus, while in one re-port, No. 11, spontaneous blisters beganto appear all over the S's body.

Evaluation of Studies

Previous evaluations of some of thesestudies have run from blanket approval10

to complete rejection.24 It must be statedat the outset that all the reported studiessuffer from a lack of rigor in reporting, ex-perimental design, or both. Thev alsohave, for the most part, the tinge of after-thought in clinical report.

Not one of the studies even approachesthe basic design postulated by Sutcliffe27

for experiments on hypnosis, lacking pri-marily the use of comparable waking con-trols. Only one study, No. 1, attempted touse even a single control S, and this wasonly to the extent of putting postagestamps (the stimulus) on "another per-son" for 18 hr. Sarbin,25 among others,has specifically criticized the select sam-ple of Ss, and the use of hysterics in par-ticular. From Table 1, under "Subject."it may be seen that: 7 Ss were hysterics, 2Ss had suffered previously from neuroticdisorders, and 3 Ss were reported to havelively vasomotor reactions, delicate skin,dermographia, or dermatitis; only 2 ap-

I *

% a g l

Ef 3 cn

g E -0

$

G

C .- 6 + & E 5 .g € 3 0 m m E s4 n- 0 2 2 4 Ma, n

N C) - Co (A

:s aJ s 52 z- rd

9.

Wet

ters

tran

d (1

915)

H

yste

rica

l, F

Tou

ch?

Rig

ht f

orea

rm

Dom

e, r

ubbe

r N

o D

erm

atol

ogis

t te

stif

ied

to a

p-

band

s, a

dhe-

pe

aran

ce o

f bl

iste

r (2

4 h

r.)

sive

pla

ster

10

. H

adfi

eld

(191

7)

Shel

l sho

ck,

M

(a)

Tou

ch?

Ant

erio

r for

earm

Se

aled

ban

dage

N

o B

llste

r on

spot

, epi

thel

ial n

ecro

- si

s in

cen

ter,

liq

uid

bene

ath,

hy

pere

mia

su

rrou

ndin

g (6

hr

.)

(b)

Tou

ch?

Lat

eral

upp

er

Seal

ed b

anda

ge

Yes

B

egin

ning

of

bl

iste

r (2

4

arm

hr

.);

form

ed

a la

rge

bleb

su

rrou

nded

by

infl

amm

atio

n

11.

Schi

ndle

r (1

927)

H

yste

rica

l ecc

hy-

Sugg

estio

n on

ly

Spot

s ab

out b

ody

Plas

ter

cast

, m

oses

, F

wat

ch g

lass

12.

Wel

ls (

194

4)

Som

nam

bul~

st~

c C

oin

Fore

arm

N

one

psyc

h. s

tude

nt

(l9

24

), M

13.

Ullm

an (

1947

) Pr

evio

us h

yste

rica

l Sm

all

flat

file

H

and,

dor

surn

N

one

blin

dnes

s-w

ar

neur

osis

, M

14

. B

orel

li &

Gee

rtz

Neu

rode

rmat

itis

- C

oin

Han

d, n

orm

al

? ( 1

953)

at

ropi

c, M

15.

Ers

kine

(19

57)

Hyp

noth

erap

y fo

r D

irec

t sug

gest

ion

Nap

e of

nec

k N

one

eye

disc

harg

e, M

duri

ng d

ay

Yes

1s

t ec

chym

oses

on

com

man

d,

then

blis

ter

of cl

ear

flui

d, fo

l-

low

ed b

y he

mor

rhag

e; s

pon-

ta

neou

s bl

iste

rs;

full

blis

ters

on

com

man

d in

5 r

nin.

N

o S

repo

rted

bl

iste

r w

ithin

3

5

min

., bu

t E r

epor

ted

no t

is-

sue

chan

ge r

esem

blin

g bl

is-

ter

whe

n ex

peri

men

t te

rmi-

na

ted

(3 hr

.)

No

Ear

ly b

liste

r fo

rmat

ion

note

d in

1 h

r., o

bser

ved;

ret

urne

d 4

hr. l

ater

with

1-c

m, b

leb

No

Shar

ply

circ

umsc

ribe

d sp

ot r

e-

sem

blin

g bl

iste

r, bu

t m

ore

appr

opri

atel

y de

scri

bed

as

whi

te d

erm

ogra

phls

m

No

Pus-

fille

d bl

iste

r on

fol

low

ing

day;

dis

appe

ared

aft

er c

ause

w

as r

evea

led

Fo

ur

add

itio

nal

cas

es r

evie

wed

hy

Pat

tiea

wer

e n

ot

rep

ort

ed b

y h

im s

ince

the

rep

ort

s w

ere

"sci

enti

fica

lly

wit

ho

ut

valu

e."

du

e to

a l

ack

of

drs

crip

tio

n o

f m

eth

- o

do

log

y.

Nu

mh

er 1

6, a

bo

ve

sho

uld

pro

hah

ly h

e d

:sca

rded

fo

r th

is r

easo

n a

lso

. T

wo

art

icle

s w

hich

may

or

may

no

t re

po

rt a

dd

itio

nal

stu

die

s on

hli

ster

pro

du

c-

tio

n w

ere

un

avlt

ilah

le t

o t

his

wri

ter;

th

ese

wer

e: 1

. Ch

apm

an.

L. F

., G

oode

ll,

H.,

& W

olff

, H

G

. C

han

ges

in t

issu

e v

uln

erab

ilit

y i

nd

uce

d b

y h

yp

no

tic

s:~

pgrs

tion

. F

ed

. P

ror.

16

:19

67

. 2.

Go

rto

n,

B.

E.

Th

e ph

ysio

logy

of

hypn

osis

: 11

. V

aso

mo

tor

acti

vit

y in

hyp

nosi

s. J

. Am

. N

or. P

eyrh

oeom

. D

ent.

4:1

32,

1957

.


pear to be "normal," but the reporting ofS characteristics was not sufficient to eval-uate these. Both of these two "normal"Ss are known to be easily hypnotizable toa somnambulistic state. Even if the sam-ple were not biased, the number is sosmall that the effect could not be spe-cifically attributed to hypnosis, much lessgeneralized to a larger population.

The lack of experimental controls is aneven greater flaw than the lack of controlSs. Orne23 has emphasized the "demandcharacteristics" of the hypnotic experi-ment, and mentions how this "demand"behavior of the Ss has led many to thinkphysiological capacities have been tran-scended. A case in point which has led tojust criticism of the blister studies comesfrom an article by von Schreck-Notzurgin 1896.24 This author reported positiveresults with hypnotic blister productionusing poor controls. The same S was usedagain, but bandaged over the suggestedarea. In this case it was discovered thatthe S had attempted self-injury by rub-bing the area and inserting a needlethrough the dressing. A cast was thenused to protect the area, leading to nega-tive results, with evidence of an attemptat self-injury. It becomes apparent thatany study in this area must include con-stant observation of the S, particularlywhen using neurotic patients, to rule outthis possibility. On this basis alone, Re-ports 1, 2, 4, 10a, 12, 13, 14, and 15, be-come questionable, if not entirely invalid.In fact, the S in No. 13 was seen to rubsnow vigorously on the area of erythema,which could account for bulla formation.4

Although the S in No. 5b was not ob-served during the entire period, an in-genious and effective device for the pre-vention of self-injury was employed, andthat study is not to be criticized on thosegrounds.

Before evaluating the studies from the pointof suggestion and stimulus contact through thefinal results, it might prove somewhat enlight-ening to review the process of blister produc-tion resulting from actual tissue damage

Lewis17 has described the response of the skinto a noxious excitant as a "triple response."The three phases of this response are: (1) lo-cal red reaction, which is only a result of theactive relaxation of the capillaries as a directfunction of pressure; (2) flare, flushing of theskin or erythema as a result of the dilatation ofarterioles (This reaction is the result of therelease of a diffusable histamine-like substance(H-substance) from the epidermal cells at thepoint of contact. Lewis believes this H-sub-stance acts as a stimulus for the sensory branchof an axon reflex, resulting in arteriole dilata-tion.) ; and (3) wheal, which is a raised swell-ing of the skin in the area of the stimulus, re-sulting from local edema (collection of serousor plasma fluid in the areolar tissue). Theedema is due to the outpouring of fluid fromthe vessels which have increased permeabilityon dilatation. This "triple response" can bebrought about by mechanical, thermal, orchemical stimuli; however, in hypersensitiveskins, very slight mechanical stimulation willresult in the reaction even more readily thanwith thermal or chemical stimuli. This is par-ticularly so with dermographism, or urticaria.

The close relationship between rash, wheal,demographia, and bulla or vesicle (blister)production is readily seen when note is takenof the physiology of sldn blisters themselves.The formation of vesicles or bullae is just afurther extension of the "triple response," inthat increased interstitual edema reaches a de-gree at which the epidermal cells can no longerresist the pressure of the fluid. At this point,the cells become separated and the fluid rushesin, collecting to form a vesicle or bleb.18

This short resume is far from complete onthe physiology of production, but will sufficefor the basic groundwork. Other relevant in-formation will be pointed out within the text.

With some amount of bullae physiologyin mind, we turn to the various stimuliwhich have been employed in the hyp-notic reports. Pattie24 originally men-tioned the possibility of confounding bymechanical stimulation, and Weitzenhof-fer29 and Barber3 have both elaboratedthis possibility. In several of the reports,the stimulus object was reportedly"pressed" upon the skin, often leaving acircumscribed red mark; i.e., the local redreaction of the first phase of the triple re-


PAUL 239

sponse. It is therefore at least a possibili-ty that those experimenters who usedsome well-defined physical object as astimulus were actually initiating somephase of the triple response by mechani-cal excitation. Reports 2,4, 5, 6,7,12,13,and 14 are particularly open to this possi-bility, and Reports 9, and 10 might alsobe included, except for their failure toreport what Ss were "touched" with.Credence is added to this alternative bythe fact that several results appear toresemble dermographia or edema ratherthan full bullae. Still another possiblesource of confounding by the stimulusobjects appears in the medical syndromeof dermatitis venenata or contact derma-titis.1 The stimulus objects applied in Re-ports 2,3,4,6,7,8b, 12, and 14 are knownto be metal objects, several of which werecoins. Schwartz and Warren26 report ahost of studies in which contact derma-titis was specifically traced to metals asthe excitant. Almost all metals have beena source of venenata, but coins, particu-larly nickel, seem to be one of the morepopular. Each of the blister studies men-tioned above, with the exception of No. 3and 8b is therefore open to this criticism.Reports 3 and 8b would appear to be freefrom criticism with regard to possible con-tact dermatitis, as well as dermographiafrom mechanical stimulation, since thepositive response appeared at a differentlocation than the stimulus. The S in Ex-periment 7 was also reported to show aresponse at a different spot from that towhich the stimulus was applied, but thevariation was at maximum 3 cm., whichdoes not rule out edema from the localinitiation.18 Another finding reported bySchwartz and Warren26 points out anextremely questionable practice in thestudies under consideration. The refer-ence here is to a study in which over half(63 of 120) of the Ss tested showed a posi-tive reaction in the form of contact der-matitis or irritation of mechanical stimu-lation, to one or more of eight adhesiveplasters tested, when the adhesive re-

VOL. XXV, N O . 3, 1963

mained in contact with the skin for a pe-riod of time. This finding casts doubt onseveral studies, particularly No. 1, inwhich postage stamps were pasted to theS's back and remained there for over 21hr. The fact that a "control S" was useddoes not lessen this possibility since therewas only one control S; that S was "an-other person"—i.e., not hysterical, and thestamps were left on the skin for a shorterperiod of time without additional dress-ings. Several other studies which reportthe skin area to be covered by a bandagecan also be questioned on these grounds,unless it was specifically reported that anadhesive substance was not placed di-rectly over the area. Studies that may bequestioned on these grounds include No.1, 2,4, 6,10b, and possibly 7 and 14. Thematchstick used in No. 5a and b may alsohave been a specific irritant, since some12 types of woods, including soft woods,as well as sulfur have been known tocause contact dermatitis.28

Still another source of doubt as to thehypnotic cause of many of the positive re-sults reported comes from a second sourceof edema. It will be remembered that themajor source of edema was the dilatationof arterioles, allowing escape of fluid inthe "triple response" reaction. A secondsource of local edema may be seen inmechanical edema.18 The primary sourceof this skin anomaly is from "a tight band-age obstructing the veins. . . . If this typeof edema is excessive, the interepitheliallymphatics participate and vesicles orbullae appear in the epidermis." It wouldseem that many of the investigators, intheir zeal to avoid the possibility of the Ssinflicting self-injury, have in fact inducedthe "injury" themselves. This unfortunate"control" confounds the reports of No. 4,6, 9, 10, and possibly 14.

Previous reviewers3-29 have investedthe majority of their time in pointing toresults in which it is questionable as towhether bullae were actually produced,or whether the reactions were better de-scribed as wheals, demographia, etc. In


view of the close relationship between thevarious reactions, as seen in the "triple re-sponse,"17 this writer does not see thenecessity of retracing these steps. Itshould only be pointed out that some ofthe reactions do stop short of actualvesicles, which Pattie24 failed to deter-mine. The one result which does requiresome attention is that of No. 12. The au-thor reported, "I had not produced anyevidence of tissue changes resembling ablister, though S had observed such." Infact the S had reported first, a red painfulcircle, followed by a blister within 35min. of the suggestion. It is quite possi-ble that some sort of edema, without tis-sue alteration actually did occur, produc-ing a white anemic center surrounded byerythema. If this were the case, the au-thor may have detected it, but failed torecognize its significance (the report wasmade from memory some 20 years afterthe "experiment"), or the overt symptoms

may have dissipated by the time the "ex-perimenter" reached the S. Unfortunate-ly, the controls in this "negative" reportare as poor as the other "successful" cases.

Validity of the Effect

Table 2 summarizes the main possiblealternative explanations covered above.In only three reported studies (No. 3, 8,and 11) can these alternatives be ruledout. These studies, as do the others, stillsuffer from a small, select number andlack of controls. In respect for profession-als colleagues, it should be mentionedthat several of the studies that have beencriticized above were performed by der-matologists and many of these sourcesmay have been controlled. In the absenceof reported controls, however, we canonly say that it is possible that their effectswere genuine.

On the basis of the three remaining re-

TABLE 2. SUMMARY OF POSSIBLE CAUSES OF POSITIVE RESULTS EXCLUDING HYPNOTIC

SUGGESTION

Experimenter

1. Focachon (1886)2. Von Krafft-Ebbing (1889)3. Jendrassick (1888)4. Rybalkin (1890)5. Doswald & Kreiback (1906)

(a)(b)

6. Heller & Schultz (1909)7. Podiapolski (1909) (a)

8. Smirnoff (1912) (a)(b)

9. Wetterstrand (1915)10. Hadfield 1917) (a)

(b)11. Schindler (1927)12. Wells (1944)13. Ullman (1947)14. Borelli & Geertz (1953)

Self-injury

PP

P

PP

P

PPP

A Iternative

Mechanicalstimulation

P

P

PPPPP

PPP

PPP

explanations*

Contactdermatitis

PPPP

PP

PPPpPp

P

P

Pp

Mechanicaledema

P

P

PPP

P

highly probable; PP, from two sources; and p, possible.


241

ports (No. 3, 8, and 11), we must tenta-tively conclude that a positive skin reac-tion, bullae, or related skin anomaly, canbe produced by hypnotic suggestion. Thebasis for this conclusion with studies No.3 and 8 is based upon the fact that thereaction was not specifically at the pointof stimulus contact, but rather seems tobe the result of a bilateral reflex action(No. 3) and responses falling within adermatome (No. 8), both of which ex-clude external cause as the sole agent. Re-port 11 is particularly significant becauseno stimulus object was used.

Since Pattie24 objected so strongly tothe idea of vasomotor control being in-fluenced by the CNS, some additionalsurvey of the literature was made to de-termine if analogous reactions of localizedvasomotor activity had been produced.Barber3 reviews several studies whichshow responses such as swelling, bruis-ing, wheals, etc. elicited with recall of atraumatic experience. Several reportshave appeared recently which purportto control or "cure" various skin disordersby hypnosis. Sarbin25 mentions improve-ment in 2 urticaria patients by hypnosis,after standard treatments had failed.Morton22 reports a case of "rash" whichcovered the patient's face and body. Us-ing direct hypnotic suggestion, he claimsto have limited the rash to the patient'shands, where "the exacerbation is easilycontrolled or eliminated via hypnosis." Aclinical report by Lait16 on an 83-year-oldfemale with a history of skin sensitivityto many local applications describes howtwo hemorrhage blebs, edema, and ery-thema were reduced within one week fol-lowing direct hypnotic suggestion of re-laxation of the muscles and vessels of theafflicted limb. A recent report by Hedge11

claims "cures" of "well advanced arterio-sclerosis" in various limbs by direct hyp-notic suggestion of vasodilation. Weightis added to the above clinical reports bylaboratory experiments of Menzies,19 inwhich vasoconstriction was conditionedin 12 of 14 Ss with a variety of conditioned

VOL. XXV, NO. 3, 1963

stimuli. Perhaps more important in dem-onstrating cerebral influence on vasomo-tor activity was an inquiry reported in thesame paper, reporting evidence of con-ditioned vasoconstriction on recall of avisual stimulus in 3 or 4 Ss. In a later pa-per, Menzies20 was able to condition vaso-constriction of the hand to a compoundstimulus in 40 trials. He again reportedinquiries in which Ss were instructed onlyto "image" specific past experiences. Of5 Ss imaging extreme cold, a fall in skintemperature was noted in every case.Directly analogous to the blister studieswere 5 of his Ss who were instructed to"image" extreme heat—e.g., steam escap-ing from a valve onto the hand. Of these5 Ss, 3 were noted to increase skin tem-perature significantly on the localizedareas in which they had previously ex-perienced extreme heat.

We may conclude, as Gorton10 has, thatvasomotor phenomena can be quantita-tively influenced, not only by hypnoticsuggestion, but by suggestion in the"waking" state, as well as autosuggestionin suitable Ss.

Subject Peculiarities

Almost every writer who has looked in-to this area has been impressed by a pe-culiar predisposition that Ss must possessin order to demonstrate overtly these "in-direct voluntary controls." Bain2 hascalled attention to the fact that the reac-tion threshold for dermatitis is loweredduring certain emotional states, explain-ing this result as being due to an increasein perspiration. Edelburg,8 likewise, re-ports a fall in tactile threshold during anincrease in autonomic activity, particular-ly when finger pulse volume is used as theindex of autonomic activity. These studiessuggest that the neurotic or hystericalcharacter of the Ss used to demonstratethe various vasomotor reactions may bea necessary component. Further sugges-tion of an especial skin sensitivity may betaken from evidence which indicates that


the skin of individuals who recurrentlyare troubled with dermatitis containsmore histamine than "normals."18 Cormia7

sheds additional light on the matter in hisstudy of pruritus thresholds. He noticedthat wheal and flare reactions followedclosely on pruritus after injections of verydilute histamine phosphate solutions. Re-activity varied from solutions of 1:10,000to 1:100,000. He found the thresholdswere progressively lower for "normals"through varying degrees of neurotics. Ofparticular importance was the fact thatnot only were the thresholds lower on in-volved skin (dermatitis) than on normalskin of the same Ss, but that many Ss pro-duced wheal and flare reactions at pointsof previous injection following "psychictrauma." "Psychic trauma" consisted ofasking the Ss to think about specific dis-turbing situations, which had been ob-tained from their case histories. Cohenet al.e also report several studies whichdemonstrate great specificity in autonom-ic responses, particularly peripheral vaso-motor activity, which were believed to bemediated by CNS activity. The latter au-thors found a correlation between CNSactivity and peripheral vasomotor activi-ty, specifically detecting venoconstriction,mediated by the sympathetic system,which was activated by the presentationof "charged" words. They hypothesizethe mechanism to be: charged words—*ARAS activation—^increased excitabilityof the posterior hypothalamus—»venocon-striction.

Brunner5 reports that the rate of tran-sudation in edema formation is greatlyincreased following "psychic trauma."He postulated that acetylcholene, liber-ated at the ends of cholinergic nerves,may have a synergetic effect with hista-mine. Cormia7 seems to have verified thishypothesis, in finding that very slight in-jections of mecholyl (an acelytcholine-like substance) greatly increased the for-mation of edema and wheal reactions.Since both andrenergic and cholinergicsubstances are increased by anxiety and

tension,21 the latter findings also give cre-dence to a postulated necessity of a par-ticular S-type, or S-state for demonstra-tion of these phenomena.

Central Influence

In attempting to explain such vasomo-tor changes that have been shown to bea function of central activity, Sarbin25 hashypothesized a shift in dominance fromcortical to subcortical levels. In view ofthe findings of Cohen et al.,6 among oth-ers, this writer would prefer to leave thedominant control in the cortex, since sug-gestion and ideomotor action are seeming-ly, always involved. There seems to belittle doubt that the anatomical structureof the brain contains the necessary cir-cuits and pathways to allow such corticalinfluence on subcortical and brain stemstructures.13 The effect of hypnosis wouldseem to be primarily, through decreasingthe sensory influx, through the relaxationprocedure, so that attention is focusedonly on the particular functions of presentrelevance. This same focusing would ap-pear to be operative in cases of "waking"Ss who show localized vasomotor reac-tions.3 Gorton's analysis10 of EEG re-sponses in hypnotized and "waking" Ss interms of "psychological set" agrees withthis proposition. Lastly, the work ofBrunner5 Cormia,7 and Johnson et aZ.15

suggests that Sarbin's "prior pathologicalexperience" or "organic readiness"25 mayin fact be a necessary component for theevocation of such vasomotor phenomena,whether viewed in terms of conditionedresponses whose cues are stored subcor-tically12 or in terms of a lower localizedthreshold.7

In conclusion, a quote from WilliamJames on ideomotor action seems inclu-sive: "The fact is that there is no sort ofconsciousness whatever, be it sensation,feeling, or idea, which does not directlyand of itself tend to discharge into somemotor effect."14


PAUL 243

Summary

A survey of the literature to 1962, hasrevealed 21 reported attempts to producenonherpetic skin blisters by hypnotic sug-gestion. Of these 21 reports, only 14 werefound to be at all satisfactory in account-ing for their methodology, procedures,and controls. Even these "experiments"were found to suffer from poor experi-mental designs, a small select population,and gross lack of controls, both in controlSs and experimental controls. Three ofthese reports were sufficiently free of al-ternative explanations for positive skinreactions to conclude that skin anomalieshad been produced by suggestion. Sev-eral additional studies on psychogenicvascular changes were reported whichadd credence to the possibility of centralcontrol of these phenomena. It was ten-tatively concluded that the anatomy andphysiology of the nervous system possessthe necessary characteristics for such re-actions to occur, but that certain idiosyn-cratic predispositions of the Ss may be anecessary component to demonstrate suchphenomena. The reactions do not appearto be limited only to hypnotized Ss; how-ever, all results to date can be viewedonly as pilot studies. In this area, as inso many others, the well-controlled, care-fully reported, parametric study is stillwaiting to be done.

University of IllinoisDept. of PsychologyPsychological Clinic

Urbana, III.

References

1. ALEXANDER, H. L. "Contact Dermati-tis." In Cecil, R. L., Textbook of Medi-cine. Saunders, Philadelphia, 1943.

2. BAIN, R. T. Skin Diseases. Regnery, Chi-cago, 1955.

3. BARBER, T. X. Physiological effects of"hypnosis." Psychol. Bull. 58:390, 1961.

4. BEAN, W. B. Vascular Spiders and Re-lated Lesions of the Skin. Thomas,Springfield, 111., 1958.

VOL. XXV, NO. 3, 1963

5. BRUNNER, M. Biologic basis of psycho-somatic disease of the skin. Arch.Dermat. U. Syph. 57:374, 1948.

6. COHEN, S. I., BONDURANT, S., and SIL-VEMAN, A. J. Psychophysiological influ-ences on peripheral venous tone. Psy-chosom. Med. 22:106, 1960.

7. CORMIA, F. E. Experimental histaminepruritus: I. Influence of physical andpsychological factors on threshold reac-tivity. / . Invest. Dermat. 29:21,1952.

8. EDELBURG, R. The relationship betweenthe galvanic skin response, vasoconstric-tion, and tactile sensitivity. / . Exper.Psychol. 62:187, 1961.

9. ERSKINE, A. A Hypnotist's Case Book.Wilshire Book Co., Hollywood, Calif.,1957.

10. GORTON, B. E. The physiology of hyp-nosis: I & II. Psychiat. Quart. 23:317,1949.

11. HEDGE, A. R. Hypnosis in circulatorydiseases. ]. Am. Inst. Hypnosis 11:42,1961.

12. HULL, C. L. Hypnosis and Suggestibility.D. Appleton-Century Co., New York,1932.

13. INGRAM, W. R. "Central AutonomicMechanisms." In Field, J., Magown, H.W., Hall, V. E., Handbook of Physiology11:951, 1960.

14. JAMES, W. Talks to Teachers on Psychol-ogy. Henry Holt, New York, 1939.

15. JOHNSON, H. H., DEOREO, G. A.,LASCHIED, W. P., and MITCHELL, F.Skin histamine levels in chronic atropicdermatitis. / . Invest. Dermat. 34:237,1960.

16. LAIT, V. S. Effect of hypnosis on edema:a case report. Am. J. Clin. Hypnosis 3:200, 1961.

17. LEWIS, T. The Blood Vessels of theHuman Skin and their Responses. Shaw& Sons, London, 1927.

18. MACLEOD, J. M. H., and MUENDE, I.Pathology of the Skin. Lewis, London,1946.

19. MENZIES, R. Conditioned vasomotor re-sponses in human subjects. /. Psychol.4:75, 1937.

20. MENZIES, R. Further studies of condi-tioned vasomotor responses in humansubjects. /. Exper. Psychol. 29:457,1941.


21. MORGAN, C. T., and STELLAR, E. Physi-ological Psychology. McGraw-Hill, NewYork, 1950.

22. MORTON, J. H. Hypnosis and psychoso-matic medicine. Am. J. Clin. Hypnosis3:67, 1960.

23. ORNE, M. T. The nature of hypnosis:artifact and essence. / . Abnorm. h- SocialPsychol. 58:277, 1959.

24. PATTIE, F. A., JR. The production ofblisters by hypnotic suggestion: a review./. Abnorm. 6- Social Psychol. 36:62,1941.

25. SARBIN, T. R. Physiological effects ofhypnotic stimulation. In Dorcus, R. M.,Hypnosis and its Therapeutic Applica-tions. McGraw-Hill, New York, 1956.

26. SCHWARTZ, L., and WARREN, L. H. Oc-cupational and related dermatoses. Pub.Health Bull. No. 266, U. S. Gov't. Print-ing Office, Washington, D. C , 1941.

27. SUTCLIFFE, J. P. "Credulous" and"skeptical" views of hypnotic phenome-na: a review of certain evidence andmethodology. Int. ]. Clin. Exper. Hyp-nosis 8:73,1960.

28. ULLMAN, M. Herpes simplex and sec-ond degree burn induced under hypnosis.Am. } . Psychiat. 203:828, 1947.

29. WEITZENHOFFER, A. M. Hypnotism: AnObjective Study in Suggestibility. Wiley,New York, 1953.

30. WELLS, W. R. The hypnotic treatmentof the major symptoms of hysteria: a casestudy. / . Psychol. 77:269, 1944.

31. WHITE, R. W. A preface to the theoryof hypnotism. /. Abnorm. &• Social Psy-chol. 36:477, 1941.

32. YOUNG, P. C. An experimental study ofmental and physical functions in the nor-mal and hypnotic states. Am. } . Psychol.37:345, 1926.

Sixth European Conferenceon Psychosomatic Research

The sixth European Conference on Psychosomatic Research will take placein Athens, Greece on May 6-8, 1964. Main topics of the conference will be(1) Psychosomatic Aspects of Heart Disease; (2) Gynecological Problems(Frigidity-Sterility-Painless Childbirth) and their Psychosomatic Approach;and (3) Skin diseases from the Psychosomatic Standpoint.

A section for the presentation of papers on topics other than these willalso be arranged. The official language of the Conference will be Englishbut a speaker may speak in French or German if his paper, translated intoEnglish, is available for all the congress members.

Address all correspondence to GEORGE S. PHILIPPOPOULOS, M.D., 4 MonisPetraki Street, Athens (140), Greece.


Documents

The Production of Blisters by Hypnotic Suggestion: Another Look